Triple-S Optimo Plus Medical Plan

Medical Option for Puerto Rico Residents

Participants located in Puerto Rico are eligible to enroll in the Optimo Plus Medical Plan through Triple S.

How the Optimo Plus Plan Works

Participants covered under the Triple-S Optimo Plus Plan do not have to meet a deductible.  However, participants must meet an annual out-of-pocket maximum of $6,350 (Individual) or $12,700 (Family).  Once the out-of-pocket maximum is met, Triple S will pay 100% of the member’s remaining covered health care expenses for the rest of the plan year. 

Participants may access care within the Triple S provider network without a referral from a primary care physician. 

Services provided by out-of-network doctors and providers in Puerto Rico will only be paid at the rate payable to in-network providers, minus the applicable participant copayment or coinsurance. Participants will be responsible for the difference between the provider’s billed amount and the Triple S established fees for participating providers. Certain services are covered in the U.S through the Blue Cross Blue Shield (BCBS) network if the participant receives prior authorization. Non-participating providers in the U.S. are covered only in emergencies and Triple S will pay these services according to the fees established by the local BCBS plan for non-participating providers.

For more information on benefit coverage and how the Plan works, refer to the Triple-S Optimo Plus Evidence of Coverage.